Summary

• me is an organized and dedicated individual wif proven track record of providing exceptional customer service and analytical expertise in fast - paced environments.
• me is an individual who is passionate about all facets of the Health Care industry and Technology wif close to six years of experience wifin both areas as well as having a bachelor’s degree in Health Science Studies from Confidential .
• me offer keen attention to detail, vast administrative experience, strong decision-making skills to manage multiple concurrent tasks, projects coordination/management, a large understanding of medical terminology as well as processes, the ability to TEMPeffectively communicate wif all levels of a Health Care or project team, and a proven ability to perform analysis and synthesize healthcare data and revenue data.

TECHNICAL SKILLS

• Complete Microsoft Suite skills/experience (Word, Excel, Outlook, and PowerPoint)
• Strong medical terminology knowledge
• Administrative support
• Data entry
• Data analysis
• Data mining
• Data migration
• Data visualization/ modeling
• Data Dashboards
• Data Warehousing
• Displays pleasant and proper phone/ email etiquette
• Data management
• Project management and project coordination
• Advanced Microsoft Excel, Pivot Tables and SQL skills/experience
• Tableau skills/experience
• Salesforce
• MATLAB
• VMware/Virtualization
• Excellent verbal and written communication skills
• Excellent customer service skills
• Attention to detail
• Typing 70 wpm
• Professional phone/ email etiquette
• Agile Development
• Jira for Agile Development
• Epic Certified, Midas, EMR/HER
• EDC R
• Python
• SAFe Framework
• SaaS
• Servicenow
• Pentaho
• Troubleshooting hardware/Ticketing ITIL
• ITSM
• Scrum
• Product Backlog Management

PROFESSIONAL EXPERIENCE

Data Analyst

Confidential, Blauvelt NY

Responsibilities:

• Assist the IT and Clinical departments in analyzing, visualizing, and modeling the data to identify trends, patterns and developmental opportunities.
• Create dashboards, reports, analyses, and studies using internal and external data sources.
• Work closely wif our SVP, Behavioral Health, Programs, Finance, and IT teams to provide thoughtful, data-backed reports and summaries, wif the intention of shaping metrics and strategic recommendations.
• Use and manage electronic health record, EHR or EMR, Connections/Cognos, Relevant, BTQ, CareLogic, etc. as well as, a variety of tools such as, Google Sheets, advanced excel, SQL, Tableau, Python, Pentaho, and others to analyze data and prepare reports that show value and help in decision making.
• Analyze, define, and report benchmarks from data to assist managed care initiatives.
• Represent data related to utilization management, claims data, revenue cycle related data, claim denial reporting by using business intelligence tools like SPSS, SQL, and Tableau to optimize, visualize, and model data from SaaS platforms, EHR updates, technical help desks, Telehealth platform, and electronic visit verifications.

Utilization Review Analyst-

Confidential - Tarrytown, NY

Responsibilities:

• Collects and organizes medical record data from multiple sources including members, care givers, physicians, registered nurses, clinical information systems and EPIC software system.
• Communicates it wif the managed care and health insurance companies to achieve continued approval of patient stays and full payment to the hospital.
• Reviews medical records, health insurance claims/appeals to analyze why a particular claim is denied as “not medically necessary” and report it to the managed care team while also responding to notices.
• Conducts daily, weekly, and monthly audits and reports for Utilization management and denial management department data.
• Assist wif the preparation of the Utilization Management Team meetings by taking/typing minutes.
• Interfaces wif and acts as a resource to team members, other MMC and CMO departments, members/caregivers, and physicians/care providers.
• Utilizing excel spreadsheets, clinical information, and medical record data via EPIC software system to create and record CRMs, BDCs, and appeal determinations.

Medical Service Coordinator

Confidential, White Plains, NY

Responsibilities:

• Develop a professional relationship wif internal and external provider offices and managed care personnel.
• Develop a professional relationship wif the staff Medical Directors and Consultants.
• Coordinate the Medical Director Reviews and Appeals between Correspondence, Claims and Insurance companies. Medical services assure that all information is received, recorded and filed in the appropriate manner.
• Reviewed, analyzed, and reported on CPT codes for Health Insurance claims companies and/or patient Operative Reports.
• Maintain the Medical Director Line documenting inquiries and results in Confidential ’s Customer Service System.
• Updating and maintaining information onto Confidential ’s claim databases via SQL database mining methods.
• Answered up to 45/50 calls per day.
• Perform other administrative duties as assigned as it relates to the essential functions of the position.
• Working closely wif other departments to assure the timely completion of all medical director reviews.

Clinical Onboarding Credentialing Analyst

Confidential - Valhalla, NY

Responsibilities:

• Credentialing experience covering all aspects of MD, DO, P.A., N.P., and CRNA hiring/onboarding process.
• Utilized various Healthcare Analytics Solutions to manage all providers’ information like EPIC, MIDAS, and other EMR software systems.
• Track up to 10-20 applications per day to ensure efficient processing and completion.
• Helped increase application completion by at least 75% since arrival.
• Assist Credentialing Coordinator wif all audits and data entry into various software programs like EPIC and MIDAS.
• Track all provider's annual Health Clearance tests, continuing education units, certifications, and licenses
• Reached out to providers’ references, schools, and places of work by utilizing proper phone and email etiquette.

Nurse Technician

Confidential - White Plains, NY

Responsibilities:

• Manage care needs for approximately 5-10 patients and increased patient satisfaction by at least 75% per shift.
• Recording patients' vital signs (Temperature, Blood Pressure, etc.).
• Documenting and reporting any changes in patients' condition directly to senior level Medical Providers.
• Performing EKG tests and drawing blood for tests.